Lab: Veterinary Suture Material Selection, Handling, and Staple Use in Small and Large Animal Surgery

What are the key points for stundets in the suture lab

1. Suture selection should be based on tissue healing characteristics.

2. Monofilament sutures have lower infection potential but are more difficult to handle.

3. Multifilament sutures provide superior handling and knot security but may increase bacterial wicking

4. Long-lasting absorbable monofilaments are preferred for body wall closure.

5. Monofilament materials are generally preferred for gastrointestinal and urinary surgery.

6. Skin staples provide rapid and effective skin closure when used appropriately.

7. Improper handling can significantly weaken otherwise appropriate suture materials.

8. Tissue preservation remains the primary goal of surgical closure.

Common Errors in Suture Selection

1. Using rapidly absorbing sutures in slow-healing tissues.

2. Using multifilament materials in contaminated wounds.

3. Selecting oversized suture unnecessarily.

4. Using nonabsorbable material within the urinary tract.

5. Using excessive suture tension.

6. Choosing suture based solely on preference rather than tissue biology.

7. Using skin staples for tissues other than skin.

8. Using larger-than-necessary needles.

Proper Removal of Skin Staples Step 1

Clean the incision.

Proper Removal of Skin Staples Step 2

Place staple remover beneath the staple center.

Proper Removal of Skin Staples Step 3

Compress the remover completely.

Proper Removal of Skin Staples Step 4

Allow the staple to bend into an "M" shape.

Proper Removal of Skin Staples Step 5

Lift the staple gently from the skin.

Proper Removal of Skin Staples Step 6

Inspect the incision after removal. Ensure all staples are removed.

Proper Application of Skin Staples step 1

Ensure wound edges are properly aligned.

Proper Application of Skin Staples step 2

Position stapler perpendicular to the incision.

Proper Application of Skin Staples step 3

Place staples 5-10 mm apart.

Proper Application of Skin Staples step 4

Verify apposition without excessive tension

Proper Application of Skin Staples step 5

Inspect closure and correct any malpositioned staples. Document number of staples placed.

What should we avoid with Application of Skin Staples

1. Stapling under excessive tension.

2. Crossing wound edges.

3. Uneven spacing.

4. Applying staples over infected tissue.

What are the indications to use Skin Staples

1. Large animal skin closure

2. Equine surgery

3. Bovine surgery

4. Trauma wounds

5. High-volume shelter surgery

6. Rapid closure of long incisions

What are the advantages to use Skin Staples

1. Rapid placement

2. Minimal tissue reaction

3. Consistent wound edge apposition

4. Reduced anesthesia time

Three Ways Sutures Fail Due to Handling Errors

1. Crushing Damage

2. Excessive Knot Tension

3. Excessive Friction or Repeated Instrument Grasping

What causes Crushing Damage

• Excessive needle holder pressure on the suture.

What is the effect for Crushing Damage

• Weakening of fibers.

• Premature breakage.

• Loss of tensile strength.

What is the cause of Excessive Knot Tension

• Overtightening knots.

What is the effect of Excessive Knot Tension

• Tissue ischemia.

• Tissue necrosis.

• Suture pull-through and dehiscence.

What is the cause for Excessive Friction or Repeated Instrument Grasping

• Repeated crushing with forceps or needle holders.

What is the effect for Excessive Friction or Repeated Instrument Grasping

• Microfractures within the suture.

• Reduced knot security.

• Early mechanical failure.

Proper Handling of Suture Material

1. Grasp the needle one-third to one-half of the distance from the swaged end.

2. Engage the needle holder securely.

3. Rotate the wrist to drive the needle through tissue.

4. Never force the needle through tissue.

What to avoid in Needle Holder Use

1. Crushing the needle.

2. Repeatedly clamping the same area of suture.

3. Pulling suture violently through tissue.

4. Dragging knots through skin.

5. Touching suture excessively with instruments.

What is the definition of Suture:

A sterile strand of material used to approximate tissue, ligate vessels or structures, or secure implants.

What is the definition of Absorbable Suture:

A suture designed to lose tensile strength and eventually be degraded within the body.

What is the definition for Nonabsorbable Suture:

A suture intended to maintain long-term tensile strength and remain indefinitely unless removed.

What is the definition for Monofilament Suture:

A suture composed of a single strand.

What is the definition for Multifilament Suture:

A suture composed of multiple braided or twisted strands.

What is the definition of Staple:

A metallic implant used for rapid skin closure.

What is the definition of Swaged Needle:

A needle manufactured with the suture permanently attached.

Appropriate suture use should be:

1. Safe

2. Deliberate

3. Precise

4. Tissue-sparing

5. Efficient

6. Species-appropriate

7. Based on tissue healing characteristics

The ideal suture:

• Maintains tensile strength until tissue heals.

• Causes minimal inflammation.

• Is easy to handle.

• Provides secure knot security.

• Minimizes infection risk.

Sutures are categorized according to:

1. Absorbable vs Nonabsorbable

2. Monofilament vs Multifilament

3. Synthetic vs Natural

4. Short-, Intermediate-, or Long-Term Strength Retention

What are examples of Monofilament Sutures

• PDS

• Monocryl

• Prolene

• Nylon

What is the description of Monofilament Sutures

Single-stranded materials.

What are the Advantages of Monofilament Sutures

• Less tissue drag

• Lower infection risk

• Reduced bacterial wicking

• Lower tissue inflammation

• Preferred in contaminated procedures

What are the Disadvantages of Monofilament Sutures

• Greater memory

• More difficult handling

• Lower knot security

• Requires additional throws for secure knots

What are the common indications of Monofilament Sutures

• Gastrointestinal surgery

• Urinary tract surgery

• Subcutaneous closure

• Contaminated wounds

• Body wall closure

What is the description of Multifilament Sutures

Braided or twisted fibers.

What are examples of Multifilament Sutures

• Vicryl

• Dexon

• Silk

• Polyester

What are the advantages of Multifilament Sutures

• Excellent handling

• Superior knot security

• Easier for beginning surgeons

• Less memory

What are the disadvantages of Multifilament Sutures

• Increased tissue drag

• Increased inflammation

• Potential bacterial wicking

• Less desirable in contaminated wounds

What are the common indications for Multifilament Sutures• Ligatures

• Clean procedures

• Ophthalmic surgery

• Situations requiring exceptional handling characteristics

Its the cats skin what kind of OT we use

3-0 to 4-0

Its the cats body wall what kind of OT we use

2-0 to 3-0

Its the cats intestine what kind of OT we use

4-0 to 5-0

Its the cats Bladder: what kind of OT we use

4-0 to 5-0

Its the dogs Bladder: what kind of OT we use

3-0 to 4-0

Its the dogs intestine: what kind of OT we use

3-0 to 4-0

Its the dogs skin: what kind of OT we use

2-0 to 4-0

Its the dogs body wall: what kind of OT we use

0 to 3-0

What are the sutures we use for horses on the skin

0 to #2

What are the sutures we use for horses on the Linea alba:

#1 to #3

What are the sutures we use for horses on the Tendons:

#2 to #5

What are the sutures we use for cows on the Tendons:

#2 to #5 (same as horse)

What are the sutures we use for cows on the body walls:

0 to #3

What are the sutures we use for cows on the skin

#1 to #3

Polydioxanone (PDS) describe it, advantages, and indications

Indications

• Linea alba

• Gastrointestinal surgery

• Urinary surgery

• Orthopedic soft tissue repair

Advantages

• Long tensile strength retention

• Minimal tissue reaction

• Excellent for slow-healing tissues

Description

Synthetic absorbable monofilament.

Monocryl describe it, advantages, and indication

Description: Synthetic absorbable monofilament.

Indications

• Subcutaneous tissues

• Intradermal closure

• Urinary tract

Advantages

• Smooth passage

• Minimal inflammation

• Excellent handling

Vicryl describe it, advantages, and indication

Description: Synthetic absorbable braided suture.

Indications

• Ligatures

• Subcutaneous tissues

• Routine soft tissue surgery

Advantages

• Excellent handling

• Strong knot security

Nylon describe it, advantages, and indication

Description: Synthetic nonabsorbable monofilament.

Indications

• Skin closure

• External sutures

What is the description, advantages and indications for Prolene

Description: Synthetic nonabsorbable monofilament.

Indications

• Skin

• Vascular surgery

Advantages

• Minimal tissue reactivity

• Excellent long-term strength

What are the indications, descriptions, and advantages of using Stainless Steel

Description: Nonabsorbable metallic material

Indications

• Orthopedics

• Sternotomy closure

• Tendon repair

Advantages

• Highest tensile strength

• Minimal tissue reaction